Digoxin to facilitate late second-trimester abortion: A randomized, masked, placebo-controlled trial

Objective: To examine the efficacy of digoxin for decreasing operative time , difficulty, and pain of late second-trimester surgical abortions. Methods: We performed a randomized, double-masked, placebo-controlled trial of intra-amniotic digoxin for second-trimester dilation and evacuation (D& E) involving 126 consecutive women at an inner-city public hospital. Eligib le women had gestational ages of 20-23.1 weeks, spoke English or Spanish, a nd were at least 16 years old. Digoxin (1 mg) or saline was injected intra- amniotically 24 hours before the procedure, at cervical laminaria insertion . The primary outcome was procedure duration. Sample size was based on 80% power to detect a difference of 3.5 minutes between groups. Results: The two groups were similar in demographic factors, obstetric hist ories, and gestational duration. The average gestational length was 22.5 we eks. There was no difference in procedure duration (mean +/- standard devia tion) between groups (placebo 14.7 +/- 7.0, digoxin 15.4 +/- 8.0). There we re no differences in blood loss estimated by surgeons, pain scores, procedu re difficulty scores, or complications between groups. Vomiting was signifi cantly more common in those who received digoxin (placebo 3.1%, digoxin 16. 1%). Most subjects (91%) reported that they preferred their fetuses were de ad before the abortions. Conclusion: Although digoxin did not increase efficacy of late second-trime ster abortion, patient preference might justify its use. (C) 2001 by The Am erican College of Obstetricians and Gynecologists.